(Editor’s note:
Donald E. Wenner is a founder of Lapsurgical Systems and co-inventor of the
Multiple Instrument Guide and does have a fiduciary interest in the product.)

While laparoscopic cholecystectomies
have become common at many same-day surgery programs, laparoscopic exploration
of the common bile duct may be less common due to available equipment and potential
damage of flexible scopes.

"I’ve been doing laparoscopic
cholecystectomies since 1990, and I do explore the common bile duct when indicated,"
says Donald E. Wenner, MD, FACS, a general surgeon specializing in laparoscopic
and vascular surgical procedures in Roswell, NM. "Exploration of the common
bile duct requires a 90 degree turn that can damage flexible scopes and does
add time to the procedure," he explains.

To address these problems,
Wenner designed the Multiple Instrument Guide (MIG) that is used with flexible
scopes. The curved plastic tube fits through the sheath and points baskets,
balloons, lasers, and other instruments right at the stone, says Wenner. Because
the MIG enables the surgeon to work through one port rather than two, procedure
time also is reduced, he adds.

"I can remove an impacted
stone in two hours and 10 minutes with the MIG as compared to three or four
hours without it," Wenner points out. The reduced time in the operating room
under anesthesia also is better for the patient, and you don’t risk injuring
the patient as you try to force the scope into a 90 degree turn, he adds.

"It is very easy for the
surgeons to use; and because surgeons can use multiple instruments through the
guide, it is less cumbersome," says Rita Jensen, RN, operating room charge
nurse at Eastern New Mexico Medical Center in Roswell.

The center began using
the MIG about three years ago as a test facility. An in-house study that examined
the incidence of scope damage showed a drop from 50% to 5% following regular
use of the MIG for common bile duct exploration, she says.

"Scopes can be very expensive
to repair, sometimes between $3,000 and $5,000," Jensen notes. "Since we began
using the MIG, we rarely have to repair any."

No special training is
required to use the MIG for the surgeon or any member of the operating team,
Wenner explains.

The MIG is disposable and
costs an average of $100. "There are some simple bile duct procedures that don’t
require the use of the MIG, but this equipment enables a surgeon to perform
the harder procedures in an ambulatory setting," he says.

In addition to improving
efficiency and reducing equipment repair costs, Wenner says that use of the
MIG is a benefit to patients as well.

"My partners and I opened
our surgery center five years ago, and we are able to provide the same level
of safety and service that patients receive in the hospital outpatient surgery
department," he adds. "Small innovations like the MIG enable patients to choose
where they want to go and get high-quality care."